Urgent:diabetic feet
Molly Pitcher C.P.O.
Description
Collection
Title:
Urgent:diabetic feet
Creator:
Molly Pitcher C.P.O.
Text:
Dear List,
I am looking for some advice on handling a very difficult diabetic foot
situation.
>This is an oral-medicated diabetic with a three-year history of bilateral
midfoot ulceration. She was fitted with CMS's at some point but these offered
little support and that's how she came to my office.
On the right she is missing her great toe and first ray. On the left, she is
missing the great toe and the MT head. On WB she is in severe equinovalgus
with forefoot abduction. Her remaining digits on both feet are clawed and
rigid. Her feet can be ranged to a neutral position(MLplane) but her heel
cord is contracted. She is without sensation below her knees. She is fully
WB using no crutches, canes or WC. She is generally a household ambulator
but goes grocery shopping and drives. She is 5'10 and weighs 200 lbs. and
is gaining more weight. Presently she has a 4-cm ulcer on both feet, which
are sterile dressed daily and debrided weekly by an orthopedic physician.
>I fitted her with a custom AFO with a well molded and padded footplate
accommodating the heel cord contracture. She wore these inside a rocker
bottom cast shoe, which was the only shoe that would accommodate them. I
urged her to use crutches or a walker but she will not follow this advice.
The AFO's reduced the forefoot abduction and elevated the midfoot. Her gait
was well balanced in them but the ulcers did not improve and she is back in
Velcro shoes with about 7 lbs. of sterile dressings covering both feet.
There is no way for her to fit into the AFO's with the dressings.
>My question regards what to do next: Will any orthosis help if she is
unwilling to unload her feet? Do you try to mold around the dressings as
best you can or do you wait for healing to start another orthosis? I did not
use the CROW walker design but is there any chance for this to be successful
if she won't use some outside support? Would a cast boot help with a molded
foot plate? I appreciate any insight you can give me regarding this
difficult situation.
Molly Pitcher CPO
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list.
I am looking for some advice on handling a very difficult diabetic foot
situation.
>This is an oral-medicated diabetic with a three-year history of bilateral
midfoot ulceration. She was fitted with CMS's at some point but these offered
little support and that's how she came to my office.
On the right she is missing her great toe and first ray. On the left, she is
missing the great toe and the MT head. On WB she is in severe equinovalgus
with forefoot abduction. Her remaining digits on both feet are clawed and
rigid. Her feet can be ranged to a neutral position(MLplane) but her heel
cord is contracted. She is without sensation below her knees. She is fully
WB using no crutches, canes or WC. She is generally a household ambulator
but goes grocery shopping and drives. She is 5'10 and weighs 200 lbs. and
is gaining more weight. Presently she has a 4-cm ulcer on both feet, which
are sterile dressed daily and debrided weekly by an orthopedic physician.
>I fitted her with a custom AFO with a well molded and padded footplate
accommodating the heel cord contracture. She wore these inside a rocker
bottom cast shoe, which was the only shoe that would accommodate them. I
urged her to use crutches or a walker but she will not follow this advice.
The AFO's reduced the forefoot abduction and elevated the midfoot. Her gait
was well balanced in them but the ulcers did not improve and she is back in
Velcro shoes with about 7 lbs. of sterile dressings covering both feet.
There is no way for her to fit into the AFO's with the dressings.
>My question regards what to do next: Will any orthosis help if she is
unwilling to unload her feet? Do you try to mold around the dressings as
best you can or do you wait for healing to start another orthosis? I did not
use the CROW walker design but is there any chance for this to be successful
if she won't use some outside support? Would a cast boot help with a molded
foot plate? I appreciate any insight you can give me regarding this
difficult situation.
Molly Pitcher CPO
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list.
Citation
Molly Pitcher C.P.O., “Urgent:diabetic feet,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/215584.
